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Prescription of 10 Drugs in Belgian Geriatric Wards

A study on the prescription of 10 drugs in Belgian geriatric wards, based on STOPP-START criteria and INAMI/RIZIV database, with insights on potentially overused and underused medications.

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Prescription of 10 Drugs in Belgian Geriatric Wards

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  1. Prescription of 10 (+1) drugsin the Belgian geriatric wards On behalf of the College of Geriatric Medicine and experts N. Van Den Noortgate, P.Meeus, O. Dalleur, B. Boland, JC Lemper, E Dejaeger, G Lambert, K Cobbaert, S Higuet, P Hanotier, JP Baeyens Data 01/12/2015

  2. QI drugs project • For 2015 , the College for GeriatricMedicineplanned to give to the Belgiangeriatricwards a feed-back on inpatientmedication prescriptions • The indicatorswerechosen on the base of STOPP-START (version 1) criteria and of the data available in the INAMI/RIZIV database • The protocolwaselaborated par N. van Van Den Noortgate (College) and P. Meeus (INAMI/RIZIV), and has been validatedby the College  cfr. QI drugs protocol • P. Meeus and his team extracted the data, whichwereprovided to the research team (NvdN, BB, JCL, OD) and at the College’s meetings in 2015  cfrthese slides: QI drugs data

  3. Time-line • Selection of inappropriatedruglists (college : 2/2015) • Selection of indicators (college : 2/2015) • Identification of the codes (team : 2/2015) • Protocole (team : 2/2015) • Methodologicaldecisions (college3 & 4/2015) • Incusion : all patients aged 75 +, hospitalized in G units in 2013 • Exclusion criteria • patients stayingat multiple unitsduring one hospitalstay • patients withstrongopioïdsduring all stay • short stays (≤ 9 days) • Unit of analysis : hospitalstaystrict in geriatric unit • Discussion of analyses (college 5, 6 & 9/2015) • Feed-back to the Glem’s/Lok’s representatives (17/11/ 2015) • Publication of results ( 12/2015)

  4. Methodology: some points • « potentially overuse » indicators are calculated on the last 6 days of the G stay • N.B.  statins and antibiotics (not in STOPP.v1) were also collected • « potentially underuse » indicators are calculated on the whole stay (anticoagulant and Vitamin D) • Two « global » indicators gathering: • All psychotrops (benzo + antidepressants+ antipsychotics) • All « potentially overuse » indicators

  5. Sample (2013): 45.086 G pure stays, (75+, min 9 days , without opioïds)

  6. chapters I. Potentiallyoveruse • Psychotrops • Benzo • Tca • Ssri • antipsychotics • other potential overuses • NSAID • Ppi • Statin • Anticholinergics II. Potentiallyunderuse (vit D – Anticoagulant)

  7. (10) Benzo : 18 %

  8. (10) Benzo : 18 %

  9. (9) TCAs : 0,8 %

  10. (9) TCAs : 0,8 %

  11. (9b) SSRI : 8 %

  12. (9b) SSRI : 8 %

  13. (11) Antipsychotics : 7 %

  14. (11) Antipsychotics : 7 %

  15. Psychotrops drugs (benzo, SSRI, TCA, antipsych): 26 %

  16. Psychotropic drugs (benzo, SSRI, TCA, antipsych): 26 %

  17. (6) PPI : 21 %

  18. (6) PPI : 21 %

  19. (5) NSAIDs: 1,1 %

  20. (5) NSAIDs: 1,1%

  21. Statins (10 %)

  22. Statins (10 %)

  23. (13) Anticholinergic (with score>3): 7 %

  24. (13) Anticholinergic (with score>3): 7 %

  25. (13) Anticholinergic (with score>3): 7 %

  26. chapters I. Potentiallyoveruse • Psychotrops • Benzo • Tca • Ssri • antipsychotics • other potential overuses • NSAID • Ppi • Statin • Anticholinergics II. Potentiallyunderuse (vit D – Anticoagulant) SUMMARY: any potential overuse

  27. Any potential (over)use : 41 %

  28. Any potential (over)use : 41 %

  29. chapters I. Potentiallyoveruse • Psychotrops • other potential overuses II. Potentiallyunderuse • vit D • Anticoagulant

  30. (14) vitamin D : 50 %

  31. (14) vitamin D : 50 %

  32. (6) OACoag (VKA + NOAC) : 14 %(to be compared with Afib prevalence)

  33. (6) OACoag (VKA + NOAC) : 14 %(to be compared with Afib prevalence)

  34. Antibiotics : 57 %

  35. Antibiotics : 57 %

  36. 10 drugs selected by the College:USE in 45.086 geriatric patients Potentially overuse • Neuro-psychotropic drugs Benzodiazepines(10.) =18 % TCAs (9a.) = 1 % SSRIs (9b.) = 7 % Antipsychotics(11.) = 7 % AnyNeuro-psy drug = 26 % • Other drugs NSAID (5.) = 1 % PPI (6.) = 21 % Statins = 10% Anticholinergic (13.) = 7 % Potentially underuse Vitamin D [vs. Osteoporosis] = 50 % (any day during the G stay) Oral anticoagulant [vs. AFib] = 14 % N.B. Antibiotics during the stay=57 %

  37. Overview PIP at G-ward (2013)

  38. Appendices: summary by ageclass and gender

  39. Appendices: summary by region and province

  40. Antwerpen

  41. Limburg

  42. Oost Vlanderen

  43. Vlaams Brabant

  44. West Vlaanderen

  45. Brussel

  46. Brabant Wallon, Namur, Luxembourg

  47. Hainaut

  48. Liege

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